Management of Acute Bleeding Upper GI Ulcers in the Era of Endoscopic and IV PPI Therapy
Bibliographic record
Abstract
BACKGROUND: Despite advances in therapy, the morbidity and mortality of gastrointestinal bleeding remains high. A review of current practice patterns was undertaken in St Boniface General Hospital, Winnipeg, Manitoba to assess the standard of care provided. OBJECTIVE: To determine whether upper gastrointestinal bleeding (UGIB) attributable to a single acute ulcer is treated appropriately with respect to local therapy, acid suppression and Helicobacter pylori status. METHODS: A retrospective chart review identified patients with consecutive acute UGIB attributable to a single gastric or duodenal ulcer presenting to a tertiary care centre over a six-month period. The lesions were classified as high- or low-risk based on endoscopic appearance. Local care of the ulcer, acid suppressive therapy and management of H. pylori were determined by reviewing pertinent chart materials. Appropriate care was defined for all three end points a priori using literature-supported standards of care. RESULTS: Fifty-five patients who met study criteria were identified. Twenty-six of 55 (47%) and 29 of 55 (52%) lesions were considered to be low- and high-risk respectively. Of the high-risk lesions, two of 29 received no local therapy, 24 of 29 received adrenaline injection and two had an endoclip placed. Of the 27 patients whose lesions were treated, 16 received thermal coagulation. Twenty-five of 29 (88%) received intravenous proton pump inhibitors. Thirty-three of 55 (55%) patients did not have H. pylori status considered in their management. CONCLUSION: Weaknesses in the management of UGIB were identified, particularly with respect to addressing the role of H. pylori. Fragmentation and compartmentalization of patient care may be important contributing factors.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".